The Public Health Agency (PHA) has set up an operations centre to co-ordinate its investigation into the E coli outbreak, as it warns that the number of victims is expected to rise.

All of the children potentially affected after eating in the same north Belfast restaurant are under the age of 14.

Yesterday afternoon saw another significant jump in the number of people who may have suffered E coli 0157 — a bacteria-cased illness which can be fatal.

By 3pm there were 20 confirmed cases and another 150 probable cases presenting symptoms of the condition. They are currently being tested to establish if they are suffering from the 0157 strain of E coli.

The number of cases has risen sharply since news of the outbreak at Flicks restaurant came to light at the weekend.

On Monday, an initial 10 suspected cases had increased to 12 confirmed victims and a further 57 probable cases.

Dr Michael Devine, a consultant in health protection at the Public Health Agency (PHA) said: “We expect to see a further increase in cases, as people continue to report symptoms and submit samples for testing.

“The further increase in cases is not unexpected as the incubation period for E coli is typically up to seven days.”

All of the 170 cases have eaten at Flicks, a burger joint in the Cityside retail centre. Just over 1,500 people passed through Flicks' doors between the start of the outbreak — on September 24 — and the day it closed on October 11.

The restaurant’s proprietor, Michael McAdam, described the toll the outbreak is having on its 10 staff members.

“It's an awful thing to have on your conscience, that something may have happened in the restaurant has caused people to be sick,” said Mr McAdam who is also managing director of the Movie House cinema chain.

“This is still under investigation. There is no conclusion yet on any of that. But it is horrible, absolutely horrible to think that people who have gone for a bite to eat, have gone home and been so ill.

“I'm just so terribly, terribly sorry that this happened to them.”

The Department of Health will this afternoon brief its committee on the outbreak — which has seen six people hospitalised.

“Anyone who ate at Flicks restaurant since September 24 and has symptoms of diarrhoea, especially bloody diarrhoea, and/or abdominal pain should contact their GP urgently for medical advice.”

It is not the first time that Flicks has come to the attention of public health authorities.

The north Belfast eaterie was investigated in August after it was linked to four cases of E coli.

Tests carried out then by the PHA came back negative.

However, a potential link between August’s cases and the escalating outbreak is now being investigated by the PHA.

This has prompted questions over why no one knew of the previous cases — and why the restaurant was not closed at the time.

A PHA spokeswoman said: “The negative tests were from swabs and food samples from the restaurant.

However we can compare the types of E coli in the four cases in August with types found in samples from cases in October.”

She added: “The PHA can confirm that this is the largest food-borne E coli outbreak in Northern Ireland.”

However, north Belfast DUP MLA Paula Bradley — who sits on the Assembly’s health committee — said: “Why was the public not informed that this had happened and no action taken?”

What began as ordinary night out has become food safety nightmare

By Anna Maguire

It was an ordinary night out — which has now become unforgettable. At least 20 people have been caught up in the E.coli outbreak — the worst ever seen in Northern Ireland — with another 150 probable cases waiting in the wings.

The link? Flicks, a popular north Belfast eaterie situated in landmark retail centre, Cityside Mall.

A spokeswoman from the Public Health Agency, which is investigating an outbreak it has described as a “major public health crisis”, said: “In the context of the probable and confirmed cases, they will all have eaten at Flicks.”

The agency said the numbers are unprecedented — and expected to rise.

The outbreak first came to light last Thursday (October 11).

Three family members who had come down with suspected E.coli 0157 on October 4 were linked to the second case highlighted on October 11.

All the individuals had eaten at Flicks. The restaurant, which was established six years ago, closed its doors on the evening of October 11 voluntarily, after it was contacted by Belfast City Council's environmental health department.

It was not the first time that the outlet had appeared on the radar of public health authorities.

Extensive tests were carried out at the restaurant in August after it was linked to four E.coli cases the same month.

“That day in August that they (environmental health inspectors) came in, they spent at least four to five hours taking food samples, taking swabs throughout the whole kitchen area,” the restaurant’s proprietor, Michael McAdam, said.

“They checked all the health and safety procedures. And after those tests were completed, nothing was found.”

Asked if the restaurant has received any complaints about its hygiene standards, he added: “Not that I’m aware.

“In June, we had a request from environmental health to do some repairs.

“We closed over the weekend of July 12 and put in new kitchen floors and new plastic walls (in line with hygiene recommendations).

Mr McAdam said the outbreak has hit the restaurant's staff hard.

However, a victim of the one of the first cases of E.coli 0157 in August has questioned whether procedures used to inspect the restaurant at that time are |sufficient. Paul Devine told the BBC’s Nolan show: “The fact that it (tests in August) comes back negative — and then it can come back positive not that long after — it makes me wonder what their procedures are |and is that process |working?”

Sue Ramsey, chairwoman of the Assembly's health committee and Belfast MLA for Sinn Fein, said: “I will be asking the department (of Health) if anything could have been done sooner.”

What’s the cause and how many are sick?

Q What are the symptoms of E coli?

A Symptoms of E coli are abdominal pain, diarrhoea — sometimes with blood — and nausea or vomiting. Dr Michael Devine, consultant in health protection at the Public Health Agency (PHA) — which is investigating the outbreak — has appealed to people to wash their hands after using the toilet and before eating or preparing food. He added: “Raw and cooked food should be kept completely separate, raw meat should be cooked through and vegetables and fruit should be washed thoroughly before eating. It's vital that everyone follows these simple rules to prevent the spread of E coli — not just those with symptoms (of E coli).

Q What is the cause of E coli?

AThe bacteria-caused illness occurs through consumption of food or water that has become contaminated by faeces from infected animals, or from exposure to an environment contaminated with animal faeces, such as farms and similar premises with animals open to the public. The condition can be fatal.

Q How many people have been affected by the E coli outbreak?

A As of 3pm yesterday, there are 20 confirmed cases and 150 probable cases of E coli 0157. A spokeswoman for the PHA said that all the probable and confirmed cases (170 in total) had eaten at Flicks Restaurant between September 24 — when the outbreak started — and October 11, when the north Belfast restaurant closed its doors voluntarily. This would indicate the source was the restaurant and not a food supplier. All of the confirmed victims are suffering from E coli 0157.

Q How serious is the current outbreak?

A The PHA says it is the largest food-borne E coli outbreak in Northern Ireland.